Provider Demographics
NPI:1548320484
Name:GILMORE, RENEE D (DC)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:D
Last Name:GILMORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19982
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-0982
Mailing Address - Country:US
Mailing Address - Phone:704-697-9818
Mailing Address - Fax:704-697-9812
Practice Address - Street 1:5200 PARK RD STE 126
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3675
Practice Address - Country:US
Practice Address - Phone:704-350-9990
Practice Address - Fax:704-303-9369
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0833MOtherCHIROPRACTIC NETWORK BCBS
NC01108OtherNC STATE HEALTH PLAN
NC8901108Medicaid
NC890833MMedicare PIN
NC2452964Medicare ID - Type Unspecified